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Passage of health care expansion came down to teamwork

By John Lyon

Arkansas News Bureau

LITTLE ROCK — Teamwork, not only between the state Senate and House but also between the Legislature and the governor’s office, were key in getting the health care expansion plan adopted during the legislative session that is scheduled to recess on Tuesday.

Passage of the plan defied expectations of unyielding Republican opposition to any form of health care expansion under the federal Affordable Care Act. It also stood in stark contrast to gridlock in Washington.

Last fall, Democratic Gov. Mike Beebe said he supported expanding Medicaid under the federal Affordable Care Act. The law proposed expanding state Medicaid rolls to include everyone earning up to 138 percent of the federal poverty level not currently on Medicaid — an estimated 250,000 people in Arkansas.

Beebe, a 20-year veteran of the state Senate who gain a reputation for being a legislative leaders and consensus builder, argued that federal health reform was going to happen and millions of taxpayer dollars could be spend on improving care for needy Arkansans or shipped out of state to help others.

The federal government would pay the full cost of the expansion for the first three years, after which the state’s share of the cost would increase gradually to 10 percent.

The idea didn’t sit well with Republicans who had just become the majority in the Legislature as a result of the November general election. Most had campaigned against again any advance of what had come to be known as Obamacare in the state.

But as the issue was being debated during the legislative session that convened Jan. 14, some Republican legislators wondered whether federal funds earmarked for Medicaid expansion could be used instead to purchase private insurance for the working poor.

Intrigued by the idea, Beebe listened to GOP lawmakers’ questions and suggestions, then pitched the unique approach to U.S. Health and Human Services Secretary Kathleen Sebelius during a trip to Washington, D.C.

Sebelius gave the go ahead to develop a plan and later said her agency supported the concept.

Last week, the state House and Senate gave final passage to a package of bills encompassing Arkansas’ alternative to Medicaid expansion, the so-called “private option.” The plan is expected to save the state $670 million over 10 years and shrink the Medicaid rolls by 35 percent.

The legislation to enable and appropriate federal money for the private option will expire after three years unless renewed by the Legislature. It also includes language that will prevent it from going into effect if the federal government does not sign off on every aspect of it.

Beebe praised Republicans and Democrats for working together to develop the program, which is being watched by governors and Legislatures across the nation.

“A lot of those folks worked extraordinarily hard with the nuts and bolts and details,” he said. “It was a bipartisan effort.”

Some in the Legislature said the Republican takeover of the House and Senate after nearly 140 years of Democratic dominance brought more balance, politically, between the legislative branch and executive branch and forced the two to work together.

“In the past, you had the governor with the Democratic majority and the policy, the policy issues, were set from the governor’s office,” said Sen. Johnny Key, R-Mountain Home. “One of the biggest policy issues this session was the Medicaid issue.

“The governor always says it’s his job to propose and its our job to dispose. I think you saw the best example of that with the Medicaid question. (Beebe) proposed expanding Medicaid as it was, and the disposition of that was a different way of dealing with Medicaid,” Key said.

He said the governor’s staff was “brought in to help with that, but that policy direction was driven by the Legislature.”

House Speaker Davy Carter, R-Cabot, who became one of the leading proponents of the private option, said that “it seems like it was the perfect makeup to make it all happen.”

Carter said a group of legislators that included Rep. John Burris, R-Harrison, and Sens. Jonathan Dismang, R-Searcy, and David Sanders, R-Little Rock, among others, “rolled their sleeves up trying to figure out a health care plan that was good for Arkansas.”

“We had a House and Senate leadership working extremely close together. I’ve talked to (Senate President Pro Tem Michael Lamoureux, R-Russellville) probably 100 times a day, and with Dismang just as many,” he said.

Also key to developing a passable plan was the governor’s willingness to listen to legislators’ ideas and take them to Washington, Carter said. Arkansas Department of Human Services Director John Selig and state Medicaid Director Andy Allison worked hard on the plan as well, he said.

“Everybody was pulling the same direction, and if we all weren’t pulling the same direction we could never have been able to put together what I think is arguably going to be the (foremost) solution to health care in the United States,” the House speaker said.

Not all Republican legislators were on board, however. A bill to appropriate federal funding for the expansion, which needed 75 votes in the 100-member House and 27 votes in the 35-member Senate, passed with just two votes to spare in the House — on the second try — and with just one vote to spare in the Senate.

GOP lawmakers who had campaigned against Medicaid expansion found themselves in an uncomfortable position. Some said they believed the private option was the best option for the state but still voted no to please constituents — and possibly to please the conservative group Americans For Prosperity, which contributed significantly to Republican candidates last fall and which opposed the private option plan.

Some objected to growing government, or complained that the Legislature was moving too fast.

Did the issue create or expose a rift in the GOP caucus? Carter said the question is not important.

“At the end of the day, there’s 77 people (in the House) that voted for it, so really, that other is irrelevant,” he said. “We did what’s best for the state. I’m proud of that. Party politics don’t trump what’s good for the state.”

Beebe said Washington politicians could learn a thing or two from what happened in Arkansas.

“If there is a message about this, the message is, ‘Washington: Republicans and Democrats can work together. … Republicans and Democrats, without regard to their party labels, can figure out what is in the best interest of their people and go solve a problem and do something for the benefit of their constituents,’” Beebe said.